September 2026
In recent years there has been a noticeable increase in the way the Care Quality Commission uses its criminal enforcement powers. Since (former police officer) Ian Trenholm became Chief Executive in 2018, the organisation has steadily moved towards a more interventionist and prosecutorial approach, and this trend has continued through 2024 and 2025, even after Mr. Trenholm’s departure.
Many providers tell us that they feel the regulator’s tone has shifted. There is often a perception that the focus is now on identifying and penalising failings rather than supporting improvement. This change has left many in the sector feeling exposed and uncertain about how to respond when the threat of prosecution arises.
Being faced with a potential criminal investigation is daunting. Understanding what the CQC can do, and how it is likely to approach enforcement, is therefore an important part of managing risk.
CQC’s enforcement powers
Most providers are familiar with the CQC’s civil powers such as requirement notices, warning notices and the suspension or cancellation of registration.
What is less widely appreciated is the growth in use of criminal tools such as cautions, fixed penalty notices and prosecutions. The legislation governing the sector, including the Health and Social Care Act 2008, the Regulated Activities Regulations 2014 and the Registration Regulations 2009, contains a wide range of criminal offences. These are most often used where there is an allegation of unsafe care or a failure that has caused, or risked causing, harm to a service user.
Bringing the prosecution
The threshold for bringing a prosecution remains relatively low. The CQC must show that a breach resulted in avoidable harm, or exposed a person to a significant risk of such harm. Where the regulator believes this test may be met, it will focus its investigation on gathering evidence to support that case.
As part of this process, providers may be invited to attend an interview under caution in accordance with the Police and Criminal Evidence Act 1984, or to provide a written response to a set of questions. These requests can feel routine, but they are a critical stage and should never be treated lightly.
Fines and sentencing
Once proceedings are underway, providers or registered persons are usually asked to indicate a plea at an early stage. Statistics published by the CQC show that very few cases proceed on a not guilty basis, in part because an early guilty plea attracts a one third reduction in any fine imposed. Fines are unlimited and recent years have seen penalties increase markedly. Average fines are now several times higher than they were prior to 2020, with some individual cases exceeding 1 million. This applies not only to large organisations; smaller providers have also faced substantial penalties where failings have led to harm.
Regulatory developments
Looking ahead to 2026, one issue that may significantly affect providers is reform of the time limits within which the CQC can prosecute. At present, most cases must be started within three years of the offence and within twelve months of the regulator obtaining sufficient evidence. There are clear indications that these limits may be extended or removed, making it easier for the CQC to pursue historic or complex cases.
How should a provider react?
In many cases the first indication that a prosecution is being considered is a letter from the CQC’s investigations team. Sometimes this is simply a notification, but it may also include requests for documents or information.
These situations are stressful, particularly when providers feel that they have already been through inspections or civil enforcement processes. It is important to pause, take advice and understand exactly what is being asked. Requests framed as ‘Section 64’ notices must generally be complied with, but many other information requests are not compulsory and may amount to little more than an attempt to build a case.
Conclusion
CQC prosecutions are no longer rare events. They form part of the regulator’s mainstream enforcement strategy and can have profound financial and reputational consequences.
Providers are best protected by ensuring that incidents are thoroughly documented, learning is clearly recorded and remedial action is demonstrable. Early advice and a measured, informed response can make a significant difference at what is often one of the most challenging points in a provider’s regulatory journey.
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